- Brighton Health Plan Solutions, LLC (Chapel Hill, NC)
- …services to its clients. The Utilization Management Nurse performs medical necessity and benefit review requests in accordance with national standards, ... changing environment- flexibility in assignment. * Proficient in Utilization Review process including benefit interpretation, contract language, medical and… more
- UNC Health Care (Kinston, NC)
- …to support the clinical documentation specialists and Patient Financial Services. Supports the Utilization Review Nurse team when necessary by applying ... management Assistants. 4. Reviews and documents findings on all medical necessity and status denials. 5. Works closely with...a Registered Nurse required. + 2 years utilization review , care management, or compliance experience… more
- Brighton Health Plan Solutions, LLC (NC)
- …services to its clients. The Utilization Management Nurse performs medical necessity and benefit review requests in accordance with national standards, ... changing environment- flexibility in assignment. * Proficient in Utilization Review process including benefit interpretation, contract language, medical and… more
- Cognizant (Raleigh, NC)
- …. Draft and submit the medical necessity determinations to the Health Plan/ Medical Director based on the review of clinical documentation in accordance with ... background - Registered Nurse (RN) . 2-3 years combined clinical and/or utilization management experience with managed health care plan . 3 years' experience in… more
- CenterWell (Raleigh, NC)
- …will collaborate with other health care givers in reviewing actual and proposed medical care and services against established CMS Coverage Guidelines/NCQA review ... RN experience; + Prior clinical experience, managed care experience, **OR** utilization management experience + Demonstrates Emotional Maturity + Ability to work… more
- UNC Health Care (Smithfield, NC)
- …Physician Advisor as necessary to resolve barriers through appropriate administrative and medical channels. 4. Utilization Outcomes Management - Monitors and ... Requirements:** * Two (2) years of clinical experience in a medical facility and/or comparable Utilization Management experience. **Knowledge/Skills/and… more
- Humana (Raleigh, NC)
- …communication of medical services and/or benefit administration determinations. The Utilization Management Nurse 2 work assignments are varied and frequently ... caring community and help us put health first** The Utilization Management Nurse 2 utilizes clinical nursing...in an acute care setting + Previous experience in utilization management/ utilization review for a… more
- Granville Medical Center (Oxford, NC)
- Registered Nurse - ICU Location: Granville Health System, Oxford, NC About Granville Health System: For over a century, Granville Health System has been at the ... Health System has extended its services throughout Granville County, ensuring convenient medical care access for its residents. The Granville Health System main… more
- Brighton Health Plan Solutions, LLC (Chapel Hill, NC)
- About The Role Brighton Health Plan Solutions (BHPS) provides Utilization Review / Medical and Case Management services for Workers' Compensation. The Workers' ... Compensation Nurse Case Reviewer collaborates with medical care...for timely return to work. + Provides case management, utilization review , continued stay reviews, and based… more
- Veterans Affairs, Veterans Health Administration (Greenville, NC)
- …determined by the VHA Education Loan Repayment Services program office after review of the EDRP application. Former EDRP participants ineligible to apply. ... Responsibilities VA offers a comprehensive total rewards package: VA Nurse Total Rewards Pay: Competitive salary, regular salary increases, potential for performance… more